I’ve been talking via email with my stepsister, Lori, whose teenage daughter has Asperger’s Syndrome. Our online conversation was mostly about the highs and lows of raising her neuro-diverse daughter and she shared with me many of the gifts that come along with having a special needs child. Then, one day, this was the message in my inbox: "Today is a day in the trenches! It's a battle and I'm bawling ...

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I recently sat by a man whose young wife was dying. Her cancer was taking her away from her husband and toddler. She was sleeping intermittently as the pain medication we administered did its work. Her husband’s eyes were red from crying and he could barely suppress a sob. He touched her and looked at me. I barely kept my own composure. I wanted to avoid that room and that patient. ...

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Until recently, there was a financial difference between performing a "consultation" and a "new patient visit" for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010). In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all.  Let’s just use this understanding as the brief background for what I’m about to say. I ...

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Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck's latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They ...

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Lately, there has been increased emphasis on "preventative" care in the US now that there are some mandates under the Affordable Care Act. The U.S. Preventative Services Task Force (USPSTF) exists, which is a panel of private sector experts who recommend evidence-based preventative screenings for certain conditions based on factors such as age and gender. As a family nurse practitioner, I base a large part of my practice on wellness and ...

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I noticed something different about my driving habits lately.  At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do: stop. I don’t do that anymore.  I always look to see if the road is clear, and other drivers have indeed stopped.  And then I go.  I have ...

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When patients are sick enough to require hospitalization, medical decisions often involve nontrivial tradeoffs between risks and benefits. They require discussions with patients and families from a variety of cultures and backgrounds. And sometimes these discussions break down. Patient-clinician communication is increasingly recognized as an integral part of clinician competency. Indeed, family-centered rounding, increasingly practiced at Children’s Hospital Boston, is a critical step in this direction. Fully adopting this practice surely ...

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During my time at PPOH, I spent one day a week working at a geriatric adult home. An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies. At best, they provide services and supports for the residents so they can live independently. At worst, they provide very little other than shelter; they just take people’s money. (The latter ...

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How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name? Now unless the pharmacist has PharmD after their name they can’t be a pharmacist.  And for the nurse, unless they have RN, BSN or RN, MSN after their name ...

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I don't know when I lost my sentimentality. Whaaap. With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on the seat and cuts the fishing line. The hook remains dangling from the lifeless mouth. He grabs the fish with his bare hand and throws it back into the water. He talks slightly ...

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